- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.85 / $4,933.00 / $4,933.00
| Facility | | $273.85 | $4,933.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,618.69 / $1,886.64 / $2,556.10
| Facility | | $1,618.69 | $1,886.64 | $2,556.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,084.20 / $1,278.05 / $1,479.39
| Facility | 50 | $1,084.20 | $1,278.05 | $1,479.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.85 / $4,933.00 / $4,933.00
| Facility | | $273.85 | $4,933.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,906.00 / $4,645.00 / $6,740.00
| Facility | | $1,906.00 | $4,645.00 | $6,740.00 |